TMPPM 2009 > Provider Information > Managed Care > PCCM

7.7.13.1 Office and Medical Records Standards

To ensure that each onsite office or facility used to deliver health care to PCCM clients is safe, sanitary, and accessible, PCCM has defined standards for offices and other facilities:

•A site visit is conducted for each location as part of the evaluation process.

•An office compliance audit ensures that the facility meets defined standards.

•Evaluators use the visit as an opportunity to interact with the provider and office staff.

•Evaluators are prepared to explain the program and promote a strong network relationship.

For a provider to be considered for PCCM participation, all office sites must be in compliance with the "conditions of participation" stipulated in the provider contract. PCCM staff conducts an office onsite review at each primary care site prior to the acceptance of the provider into PCCM. Subsequently, Provider Relations staff performs routine audits at primary care office sites every two years.

The "Primary Care Case Management (PCCM) Pre-Contractual/Recredentialing Site and Medical Record Evaluation" is used to evaluate a provider's office:

•Offices that are found to be marginally acceptable receive a follow-up visit within 90 days.

•PCCM may recommend that HHSC cancel a provider's contract if office conditions do not meet defined standards after notice of required corrective action has been provided, and time to make changes has been made available.